WO1997009006A1 - Endovascular support device and method of use - Google Patents

Endovascular support device and method of use Download PDF

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Publication number
WO1997009006A1
WO1997009006A1 PCT/US1996/013907 US9613907W WO9709006A1 WO 1997009006 A1 WO1997009006 A1 WO 1997009006A1 US 9613907 W US9613907 W US 9613907W WO 9709006 A1 WO9709006 A1 WO 9709006A1
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WO
WIPO (PCT)
Prior art keywords
therapeutic agent
support device
endovascular
pericardial tissue
inhibitor
Prior art date
Application number
PCT/US1996/013907
Other languages
French (fr)
Inventor
Ron Waksman
Spencer B. King
Neal A. Scott
Original Assignee
Emory University
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Emory University filed Critical Emory University
Priority to EP96929790A priority Critical patent/EP0853465A4/en
Priority to AU69056/96A priority patent/AU6905696A/en
Publication of WO1997009006A1 publication Critical patent/WO1997009006A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/54Biologically active materials, e.g. therapeutic substances
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/82Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/86Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
    • A61F2/90Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/95Instruments specially adapted for placement or removal of stents or stent-grafts
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • A61F2002/072Encapsulated stents, e.g. wire or whole stent embedded in lining
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/04Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2/06Blood vessels
    • A61F2/07Stent-grafts
    • A61F2002/075Stent-grafts the stent being loosely attached to the graft material, e.g. by stitching
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0067Means for introducing or releasing pharmaceutical products into the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/40Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
    • A61L2300/412Tissue-regenerating or healing or proliferative agents
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/40Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
    • A61L2300/416Anti-neoplastic or anti-proliferative or anti-restenosis or anti-angiogenic agents, e.g. paclitaxel, sirolimus
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/40Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
    • A61L2300/42Anti-thrombotic agents, anticoagulants, anti-platelet agents
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/40Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
    • A61L2300/432Inhibitors, antagonists
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61LMETHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2300/00Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
    • A61L2300/60Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a special physical form
    • A61L2300/602Type of release, e.g. controlled, sustained, slow

Definitions

  • the present invention relates to the field of endovascular support to maintain patency of narrowed vessels and facilitate repair of injured or degenerated vessels by implantation of a device within the target vessel. More specifically, the invention relates to acceptable biological coverings for an endovascular support device and the local delivery of a therapeutic substance into the vascular tissue, as a complementary treatment.
  • Partial and even complete blockage ofthe vascular system by the formation of an atherosclerotic plaque is a well known and frequent medical problem.
  • Such blockages are often treated with percutaneous transluminal coronary angioplasty (PTCA), also known as balloon angioplasty, or by intravascular stent implantation.
  • PTCA percutaneous transluminal coronary angioplasty
  • PTCA is an alternative to vascular bypass surgery, which includes a surgically exposing incision, and removing, replacing, or bypassing the defective blood vessel.
  • Structures which have previously been used as intraluminal vascular grafts have included coiled stainless steel springs, and grafted stents made out of synthetic material (Dacron or PTFE). Examples of such prior art devices may be found in U.S. Patent Nos. 5,306,286; 5,026,377; 5,019,085; 5,019,090; 4,913,141; 4,886,062; 4,733,665; and 4,503,569.
  • the balloon In balloon dilatation of vascular stenosis, or blockages, the balloon is inflated
  • Vascular prosthetic devices are often utilized in an effort to maintain vessel patency and prevent restinosis.
  • vascular prosthetic devices or patches are often associated with increased thrombogenicity ofthe PTCA site due to the blood contacting the surfaces ofthe prosthetic device, and result in occlusion ofthe vesicle.
  • synthetic materials used in conventional endovascular prostheses tend to
  • a device and method for supporting endovascular vessels which provides local therapy for repairing those blood vessels narrowed or occluded by disease, and which provides a biologically acceptable substrate for grafting to the patient.
  • a device which includes providing local therapy resulting in high local concentrations of therapeutic drugs at the treatment site.
  • the art has sought such an expandable intraluminal vascular support graft, and alternatively an independent arterial-vascular fistula, which prevents recurrence of stenosis, to be utilized to support or replace degenerated vein grafts, coronary arteries, and the peripheral arterial and venous system.
  • the present invention provides an endovascular support device adapted for local delivery of a therapeutic agent and for minimizing the rate of restinosis.
  • the device has a cylindrical support body having an inside surface and an outside surface.
  • the endovascular support device ofthe present invention also has at least one layer of pericardial tissue covering at least a portion ofthe inside surface or the outside surface ofthe cylindrical support body.
  • the endovascular support device ofthe present invention is provided with a therapeutic agent disposed on a portion thereof.
  • Fig. 1 is a perspective view ofthe endovascular support device in accordance with one embodiment ofthe invention positioned on a balloon catheter delivery means inside a vesicle.
  • Fig. 2 is a cross section view ofthe endovascular support device taken along the plane defined by the line 2-2 in Fig. 1, and positioned within a vesicle.
  • Fig. 3 is a partial cut away view ofthe pericardial tissue ofthe endovascular support device with micropores disposed therethrough for delivery of a therapeutic agent.
  • Fig. 4 is a schematic side view of six (Figs. 4A-4F) alternative embodiments of the endovascular support device ofthe present invention.
  • the present invention provides an endovascular support device 10 adapted for local delivery of a therapeutic agent 50 and for minimizing the rate of restinosis.
  • the device 10 has a cylindrical support body 12
  • the cylindrical support having an inside surface 14 and an opposite outside surface 16.
  • the support body 12 may be constructed of an expandable flexible wire coil or a tubular mesh of multiple coils or rings.
  • the support body 12 may be constructed of a molded polymer, or similarly rigid substance, or a combination ofthe two.
  • An expandable support material can permit precise positioning and maintenance ofthe device 10 within a bodily vesicle 25, with the assistance of an angioplasty balloon
  • a guide wire 18 is inserted within the vesicle 25 to the point where endovascular support is desired.
  • the present invention is moved through the vesicle 25 along the guide wire 18.
  • the balloon 17 is inflated and the device 10 is positioned against the walls of
  • the endovascular support device 10 can be used within existing and grafted vesicles in a patient.
  • the device 10 may be positioned within a vesicle for a variety of purposes, such as for structural support or to occlude an
  • the device 10 can be used independently to provide a vascular replacement for ineffective vesicles, or as a separate fistula as for dialysis.
  • the endovascular support device 10 ofthe present invention also has at least one layer of pericardial tissue 20 covering at least a portion of the inside surface 14 or the outside surface 16 ofthe cylindrical support body 12.
  • the pericardial tissue 20 provides a thin- walled membrane made of biological tissue to promote acceptance and fusion with the patient's blood vessel 25 tissue.
  • the support device 10 surface may have an adjustable thickness by varying the number of tissue 20 layers.
  • the pericardium may be chosen from any mammal, but is preferably of porcine, bovine, or human origin.
  • porcine pericardium may be retrieved from that surrounding the heart of a sacrificed pig. After shaving the excess fat, the tissue can be immersed in 0.2% glutaraldehyde, which creates permanent strengthening chemical cross-links. The porcine pericardium can then be immersed in porcine albumin solution. When the pericardium is wrapped on the support body 12, it may be adhered to the
  • the pericardial tissue may be stored in a cold electrolyte solution until used.
  • Pericardial tissue provides a su ⁇ risingly effective biological endovascular support covering. This feature is due, at least in part, to the strength and elasticity of the tissue.
  • the pericardium also has a very low degree of thrombogenicity and is biocompatible with graft recipients. Furthermore, the pericardium serves as an excellent drug delivery means, due to its porosity and high collagen content.
  • the endovascular support device 10 ofthe present invention can be provided
  • therapeutic agent any compound which has a desired pharmacologic effect.
  • disposed on is meant that the therapeutic agent 40 is in contact with at least a portion ofthe
  • the therapeutic agent 40 can be soaked into the tissue or polymer over a period of time, or alternatively, can be injected into a reservoir or cavity created by layers of these materials.
  • the invention contemplates that the device 40 may be made available either presoaked with a therapeutic agent, or provided such that a therapeutic agent is chosen for soaking or injection into the reservoir just prior to placement ofthe device 10 in the patient.
  • the therapeutic agent 40 can be an anticoagulant, such as D- Phe-Pro-Arg chloromethyl ketone, an RGD peptide-containing compound, heparin, an antithrombin compound, a platelet receptor antagonist, an anti-thrombin antibody, an anti-platelet receptor antibody, aspirin, a prostaglandin inhibitor, a platelet inhibitor or a
  • an anticoagulant such as D- Phe-Pro-Arg chloromethyl ketone, an RGD peptide-containing compound, heparin, an antithrombin compound, a platelet receptor antagonist, an anti-thrombin antibody, an anti-platelet receptor antibody, aspirin, a prostaglandin inhibitor, a platelet inhibitor or a
  • the therapeutic agent 40 can be a promoter of vascular cell growth, such as a growth factor stimulator, a growth factor receptor agonist, a transcriptional activator, and a translational promoter.
  • the therapeutic agent 40 can be an inhibitor of vascular cell growth, such as a growth factor inhibitor, a growth factor receptor antagonist, a transcriptional repressor, a translational repressor, an antisense DNA, an antisense RNA, a replication inhibitor, an inhibitory antibody, an antibody directed against growth factors, a bifunctional molecule consisting of a growth factor and a cytotoxin, or a bifunctional molecule consisting of an antibody and a cytotoxin.
  • the therapeutic agent 40 can be a cholesterol-lowering agent, a vasodilating agent, or other agents which interfere with endogenous vasoactive mechanisms. Additionally, the therapeutic agent 40 can be a smooth muscle inhibitor, such as: an agent that modulates intracellular calcium binding proteins; a receptor blocker for contractile agonists; an inhibitor ofthe sodium/hydrogen antiporter; a protease inhibitor; a nitro vasodilator; a phosphodiesterase inhibitor; a phenothiazine; a growth factor receptor agonist; an anti-mitotic agent; an immunosuppressive agent; or a protein kinase inhibitor.
  • a smooth muscle inhibitor such as: an agent that modulates intracellular calcium binding proteins; a receptor blocker for contractile agonists; an inhibitor ofthe sodium/hydrogen antiporter; a protease inhibitor; a nitro vasodilator; a phosphodiesterase inhibitor; a phenothiazine; a growth factor receptor agonist; an anti
  • the therapeutic agent 40 may be disposed on all or a portion ofthe pericardial
  • tissue 20 to utilize the biological properties ofthe material to absorb different drugs
  • the pericardial tissue 20 can have a plurality of micropores 22 that extend therethrough for more effective delivery ofthe therapeutic agent 40.
  • the micropores 22 may also be made to extend only partially into one surface ofthe tissue 20, and not extend entirely therethrough, such that the therapeutic agent 40 can be directed to diffuse primarily in the direction ofthe micropores. For example, if only one layer of pericardial tissue 20 is employed in the endovascular support device 10, the surface ofthe pericardial tissue 20 is employed in the endovascular support device 10.
  • micropores 22 intended to face outward can have a plurality of micropores 22 disposed thereon for
  • Micropores 22 can be made in
  • the therapeutic agent 40 may be disposed on all or a portion of a polymer 50, which can be biodegradable and adapted for slow release ofthe therapeutic agent 40.
  • a polymer 50 laden with one or more therapeutic agents 40 can be positioned
  • pericardial tissue 20 or imbedded between multiple layers of pericardial tissues 20.
  • the polymer 50 can be constructed so as to form the cylindrical support body 12 itself, then wrapped at least partially with at least one layer of pericardial tissue 20.
  • a biodegradable polymer 50 such as polylactide, polyanhydride, polyorthoester or polyglycolide, for example can be used.
  • synthetic polymers natural polymers can be used, such as amino acid polymers or polysaccharides.
  • the polymer's 50 compatibility with a patient is selected depending on the drug required, the polymer's 50 compatibility with a patient and the ultimate pharmacologic effect desired. For example, if the effect need only last a
  • a thin polymer 50 can be used with a limited amount of drug capable of diffusing from the polymer 50 into the arterial wall or lumen ofthe vesicle 25.
  • a thin polymer 50 which is biodegradable over a long period of time.
  • the opposite characteristics would be selected for
  • the device 10 can be comprised of two or more different therapeutic agents
  • the polymers 50 can have different solubilities or diffusion
  • Figures 4A-4F show a variety of combinations ofthe device 10 elements: the
  • support body 12 pericardial tissue 20, and polymer 50, contemplated as different
  • the therapeutic agent 40 may be disposed on any or all of these elements. As discussed above, the therapeutic agent 40 can be, for example, soaked into the pericardial tissue or polymer, laminated on the pericardial tissue or polymer, or injected into a reservoir
  • Figure 4A shows one embodiment in which the support
  • body 12 has a pericardial tissue 20 disposed on both the inside surface 14 and outside
  • FIG. 4B shows the support body 12 covered on
  • FIG. 4C shows an embodiment in which the
  • support body 12 is covered on the inside surface 14 with a layer of polymer 50 which is in turn covered by a layer of pericardial tissue 20, and the outside surface 16 ofthe
  • support body 12 is covered by a layer of polymer 50.
  • Figure 4D is the embodiment also shown in cross section in Figure 2. This
  • embodiment has the support body 12 sandwiched on the inside surface 14 and the
  • the support body 12 is covered on the inside surface 14 by a layer of polymer 50, and on
  • Figure 4F shows an embodiment having a layer of polymer 50 disposed on the inside surface 14 and a layer of polymer 50 disposed on the outside surface, which is also coated with a layer of
  • the present invention also provides methods of using the device 10 to support
  • an endovascular vessel 25 and to locally deliver a therapeutic agent 40 to minimize the
  • the invention provides methods for treating or

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Abstract

This invention is an endovascular support device (10) adapted for local delivery of a therapeutic agent (50) for minimizing the rate of restenosis having a cylindrical support body (12) with an inside surface (14), an opposite outside surface (16), and at least one layer of pericardial tissue (20) covering at least a portion of at least a selected one of the inside surface (14), or the outside surface (16) of the cylindrical support body (12). At least one therapeutic agent (50) is disposed on a portion of the support device (10).

Description

ENDOVASCULAR SUPPORT DEVICE AND METHOD OF USE
FIELD OF THE INVENTION
The present invention relates to the field of endovascular support to maintain patency of narrowed vessels and facilitate repair of injured or degenerated vessels by implantation of a device within the target vessel. More specifically, the invention relates to acceptable biological coverings for an endovascular support device and the local delivery of a therapeutic substance into the vascular tissue, as a complementary treatment.
BACKGROUND OF THE INVENTION
Partial and even complete blockage ofthe vascular system by the formation of an atherosclerotic plaque is a well known and frequent medical problem. Such blockages are often treated with percutaneous transluminal coronary angioplasty (PTCA), also known as balloon angioplasty, or by intravascular stent implantation. PTCA is an alternative to vascular bypass surgery, which includes a surgically exposing incision, and removing, replacing, or bypassing the defective blood vessel. Structures which have previously been used as intraluminal vascular grafts have included coiled stainless steel springs, and grafted stents made out of synthetic material (Dacron or PTFE). Examples of such prior art devices may be found in U.S. Patent Nos. 5,306,286; 5,026,377; 5,019,085; 5,019,090; 4,913,141; 4,886,062; 4,733,665; and 4,503,569.
In balloon dilatation of vascular stenosis, or blockages, the balloon is inflated
within the stenosed vessel, in order to shear and disrupt the wall component ofthe
vessel to obtain an enlarged lumen. This may create a flap or tear at the intima or the media ofthe vessel wall. The intimal flap can fold down into the lumen and may occlude the vessel. Such occurrences contribute to the high incidence of restinosis which is prevalent. Currently, conventional balloon angioplasty is followed by roughly a
30% to 50% incidence of restenosis.
Vascular prosthetic devices are often utilized in an effort to maintain vessel patency and prevent restinosis. However, vascular prosthetic devices or patches are often associated with increased thrombogenicity ofthe PTCA site due to the blood contacting the surfaces ofthe prosthetic device, and result in occlusion ofthe vesicle. Additionally, synthetic materials used in conventional endovascular prostheses tend to
reject coverage by the patient's living tissue, i.e. endothelium, and have collecting surfaces that become thrombogenic sites. Previous biological materials suggested in the art for use in endovascular support have not provided a satisfactory ability to graft to the patient's tissues. Moreover, the body's own repair mechanisms can bring progressive stenotic occlusion due to neointimal fibrosis and hyperplasia. Additionally, an immunological response to foreign material can lead to increased inflammation in
response to the prosthetic device. Systemic therapy aimed at preventing coagulation, a thrombosis locally at the graft site, is often complicated at other sites and produces unwanted, even dangerous side effects. Likewise, systemic treatment with growth mediators or chemotherapeutic agents can produce a hyperplastic or hypoplastic response in tissue not specifically targeted. Existing stent devices, such as dip coated stents, providing locally delivered drugs do not satisfactorily promote grafting or integration ofthe stent into the patient's endothelium. See for example U.S. Patent Nos. 5,383,928 and 5,102,417.
Therefore, there exists a need in the art for a device and method for supporting endovascular vessels, which provides local therapy for repairing those blood vessels narrowed or occluded by disease, and which provides a biologically acceptable substrate for grafting to the patient. There is a need for such a device which includes providing local therapy resulting in high local concentrations of therapeutic drugs at the treatment site. The art has sought such an expandable intraluminal vascular support graft, and alternatively an independent arterial-vascular fistula, which prevents recurrence of stenosis, to be utilized to support or replace degenerated vein grafts, coronary arteries, and the peripheral arterial and venous system.
However, prior to the development ofthe present invention, there has been no expandable intraluminal graft comprised of a biological material which prevents recurrence of restenosis that can also be utilized to deliver drugs locally to the desired location. SUMMARY OF THE INVENTION
The present invention provides an endovascular support device adapted for local delivery of a therapeutic agent and for minimizing the rate of restinosis. The device has a cylindrical support body having an inside surface and an outside surface. The endovascular support device ofthe present invention also has at least one layer of pericardial tissue covering at least a portion ofthe inside surface or the outside surface ofthe cylindrical support body. The endovascular support device ofthe present invention is provided with a therapeutic agent disposed on a portion thereof.
BRIEF DESCRD? TIONS OF THE DRAWINGS
Fig. 1 is a perspective view ofthe endovascular support device in accordance with one embodiment ofthe invention positioned on a balloon catheter delivery means inside a vesicle.
Fig. 2 is a cross section view ofthe endovascular support device taken along the plane defined by the line 2-2 in Fig. 1, and positioned within a vesicle.
Fig. 3 is a partial cut away view ofthe pericardial tissue ofthe endovascular support device with micropores disposed therethrough for delivery of a therapeutic agent. Fig. 4 is a schematic side view of six (Figs. 4A-4F) alternative embodiments of the endovascular support device ofthe present invention.
DETAILED DESCRIPTION OF THE INVENTION
Referring to Figures 1-4, the present invention provides an endovascular support device 10 adapted for local delivery of a therapeutic agent 50 and for minimizing the rate of restinosis. The device 10 has a cylindrical support body 12
having an inside surface 14 and an opposite outside surface 16. The cylindrical support
body 12 may be constructed of an expandable flexible wire coil or a tubular mesh of multiple coils or rings. Alternatively, the support body 12 may be constructed of a molded polymer, or similarly rigid substance, or a combination ofthe two.
An expandable support material can permit precise positioning and maintenance ofthe device 10 within a bodily vesicle 25, with the assistance of an angioplasty balloon
16, as shown in Figure 1. In common use, a guide wire 18 is inserted within the vesicle 25 to the point where endovascular support is desired. An angioplasty balloon 17, or
other similar positioning device, carrying the endovascular support device 10 ofthe
present invention, is moved through the vesicle 25 along the guide wire 18. At the
desired site, the balloon 17 is inflated and the device 10 is positioned against the walls of
the vesicle. The angioplasty balloon 17 and guide wire 18 are then removed, leaving the device 10 in place to support the vesicle 25. The invention contemplates that the endovascular support device 10 can be used within existing and grafted vesicles in a patient. The device 10 may be positioned within a vesicle for a variety of purposes, such as for structural support or to occlude an
associated aneurysm, for example. The invention also contemplates that the device 10 can be used independently to provide a vascular replacement for ineffective vesicles, or as a separate fistula as for dialysis.
Referring to Figures 2 and 4, the endovascular support device 10 ofthe present invention also has at least one layer of pericardial tissue 20 covering at least a portion of the inside surface 14 or the outside surface 16 ofthe cylindrical support body 12. The pericardial tissue 20 provides a thin- walled membrane made of biological tissue to promote acceptance and fusion with the patient's blood vessel 25 tissue. The support device 10 surface may have an adjustable thickness by varying the number of tissue 20 layers. The pericardium may be chosen from any mammal, but is preferably of porcine, bovine, or human origin.
One skilled in the art will know how to prepare such a pericardial tissue 20 for a homograft or xenograft. For example, porcine pericardium may be retrieved from that surrounding the heart of a sacrificed pig. After shaving the excess fat, the tissue can be immersed in 0.2% glutaraldehyde, which creates permanent strengthening chemical cross-links. The porcine pericardium can then be immersed in porcine albumin solution. When the pericardium is wrapped on the support body 12, it may be adhered to the
support body 12 with a biocompatible glue or by careful suturing. The pericardial tissue may be stored in a cold electrolyte solution until used. Pericardial tissue provides a suφrisingly effective biological endovascular support covering. This feature is due, at least in part, to the strength and elasticity of the tissue. The pericardium also has a very low degree of thrombogenicity and is biocompatible with graft recipients. Furthermore, the pericardium serves as an excellent drug delivery means, due to its porosity and high collagen content.
The endovascular support device 10 ofthe present invention can be provided
with at least one therapeutic agent 40 disposed on a portion thereof. By "therapeutic agent" is meant any compound which has a desired pharmacologic effect. By "disposed on" is meant that the therapeutic agent 40 is in contact with at least a portion ofthe
tissue or polymer, described below. For example, the therapeutic agent 40 can be soaked into the tissue or polymer over a period of time, or alternatively, can be injected into a reservoir or cavity created by layers of these materials. The invention contemplates that the device 40 may be made available either presoaked with a therapeutic agent, or provided such that a therapeutic agent is chosen for soaking or injection into the reservoir just prior to placement ofthe device 10 in the patient.
More specifically, the therapeutic agent 40 can be an anticoagulant, such as D- Phe-Pro-Arg chloromethyl ketone, an RGD peptide-containing compound, heparin, an antithrombin compound, a platelet receptor antagonist, an anti-thrombin antibody, an anti-platelet receptor antibody, aspirin, a prostaglandin inhibitor, a platelet inhibitor or a
tick anti-platelet peptide. The therapeutic agent 40 can be a promoter of vascular cell growth, such as a growth factor stimulator, a growth factor receptor agonist, a transcriptional activator, and a translational promoter. Alternatively, the therapeutic agent 40 can be an inhibitor of vascular cell growth, such as a growth factor inhibitor, a growth factor receptor antagonist, a transcriptional repressor, a translational repressor, an antisense DNA, an antisense RNA, a replication inhibitor, an inhibitory antibody, an antibody directed against growth factors, a bifunctional molecule consisting of a growth factor and a cytotoxin, or a bifunctional molecule consisting of an antibody and a cytotoxin.
The therapeutic agent 40 can be a cholesterol-lowering agent, a vasodilating agent, or other agents which interfere with endogenous vasoactive mechanisms. Additionally, the therapeutic agent 40 can be a smooth muscle inhibitor, such as: an agent that modulates intracellular calcium binding proteins; a receptor blocker for contractile agonists; an inhibitor ofthe sodium/hydrogen antiporter; a protease inhibitor; a nitro vasodilator; a phosphodiesterase inhibitor; a phenothiazine; a growth factor receptor agonist; an anti-mitotic agent; an immunosuppressive agent; or a protein kinase inhibitor.
The therapeutic agent 40 may be disposed on all or a portion ofthe pericardial
tissue 20 to utilize the biological properties ofthe material to absorb different drugs and
to release them slowly after deployment to the adjacent tissue. As seen in Figure 3, the pericardial tissue 20 can have a plurality of micropores 22 that extend therethrough for more effective delivery ofthe therapeutic agent 40. The micropores 22 may also be made to extend only partially into one surface ofthe tissue 20, and not extend entirely therethrough, such that the therapeutic agent 40 can be directed to diffuse primarily in the direction ofthe micropores. For example, if only one layer of pericardial tissue 20 is employed in the endovascular support device 10, the surface ofthe pericardial tissue 20
intended to face outward can have a plurality of micropores 22 disposed thereon for
delivery ofthe therapeutic agent 50 primarily toward the adjacent walls ofthe blood
vesicle 25, and not toward the interior ofthe vesicle 25. Micropores 22 can be made in
the tissue 20 by a variety of means, including by laser incision.
Alternatively, the therapeutic agent 40 may be disposed on all or a portion of a polymer 50, which can be biodegradable and adapted for slow release ofthe therapeutic agent 40. A polymer 50 laden with one or more therapeutic agents 40 can be positioned
on portion ofthe cylindrical support body 12, wrapped around a portion ofthe
pericardial tissue 20, or imbedded between multiple layers of pericardial tissues 20.
Alternatively, the polymer 50 can be constructed so as to form the cylindrical support body 12 itself, then wrapped at least partially with at least one layer of pericardial tissue 20.
A biodegradable polymer 50 such as polylactide, polyanhydride, polyorthoester or polyglycolide, for example can be used. In addition to synthetic polymers, natural polymers can be used, such as amino acid polymers or polysaccharides. The polymer 50
is selected depending on the drug required, the polymer's 50 compatibility with a patient and the ultimate pharmacologic effect desired. For example, if the effect need only last a
short period, a thin polymer 50 can be used with a limited amount of drug capable of diffusing from the polymer 50 into the arterial wall or lumen ofthe vesicle 25. Alternatively, only the layer closest to the body fluid would contain the therapeutic agent 40. Another alternative would be to use a polymer 50 which is biodegradable over a long period of time. Naturally, the opposite characteristics would be selected for
a desired prolonged release.
The characteristics ofthe particular polymer 50 for these purposes is well known to the skilled artisan or can be determined by reference to standard references, e.g., Biodegradable Polymers as Drug Delivery Systems, R. Langer and M. Chasin, Eds., Marcel Dekker Inc., New York, NY, USA (1990); Engleberg and Kohn, "Physico- mechanical properties of degradable polymers used in medical applications: a comparative study," Biomaterials 12:292-304 (1991); Controlled Release Delivery
Systems, T. J. Roseman and S. D. Mansdorf, Eds., Marcel Dekker Inc., New York, NY, USA (1983); and "Controlled Release Technology, Pharmaceutical Applications, ACS Symposium Series, Vol. 348, P. I. Lee and W. R. Good, Eds., American Chemical Society, Washington, D.C, USA (1987).
Generally, the polymer 50 has a therapeutic agent 40 release rate of between about .001 μg/cm2-min and about 100 μg/cm2-min, especially between about .01
μg cm2-min and 10 μg/cm2 -min. In addition, the polymer 50 generally has a thickness of between about .01 mm and 10 mm, especially between about .1 mm and 1 mm. As can
be appreciated, the device 10 can be comprised of two or more different therapeutic
agents 40 or two or more different polymers 50 to obtain a desired effect and release
rate. In addition, the polymers 50 can have different solubilities or diffusion
characteristics to accomplish non-uniform therapeutic agent 40 release. Figures 4A-4F show a variety of combinations ofthe device 10 elements: the
support body 12, pericardial tissue 20, and polymer 50, contemplated as different
embodiments ofthe present invention. It is understood from the above description that
the therapeutic agent 40 may be disposed on any or all of these elements. As discussed above, the therapeutic agent 40 can be, for example, soaked into the pericardial tissue or polymer, laminated on the pericardial tissue or polymer, or injected into a reservoir
formed by these materials. Figure 4A shows one embodiment in which the support
body 12 has a pericardial tissue 20 disposed on both the inside surface 14 and outside
surface 16 thereof. Certainly, the invention contemplates that pericardium tissue 20 can be disposed on either surface alone. Figure 4B shows the support body 12 covered on
the inside surface 14 by a layer of pericardial tissue 20, and covered on the outside surface 16 by a layer of polymer 50. Figure 4C shows an embodiment in which the
support body 12 is covered on the inside surface 14 with a layer of polymer 50 which is in turn covered by a layer of pericardial tissue 20, and the outside surface 16 ofthe
support body 12 is covered by a layer of polymer 50.
Figure 4D is the embodiment also shown in cross section in Figure 2. This
embodiment has the support body 12 sandwiched on the inside surface 14 and the
outside surface 16 between two layers of polymer 50, which is in turn sandwiched
between two layers of pericardial tissue 20. Figure 4E presents an embodiment wherein
the support body 12 is covered on the inside surface 14 by a layer of polymer 50, and on
the outside surface 16 by a layer of pericardial tissue 20. Finally, Figure 4F shows an embodiment having a layer of polymer 50 disposed on the inside surface 14 and a layer of polymer 50 disposed on the outside surface, which is also coated with a layer of
pericardial tissue 20.
The present invention also provides methods of using the device 10 to support
an endovascular vessel 25 and to locally deliver a therapeutic agent 40 to minimize the
rate of restenosis. More particularly, the invention provides methods for treating or
preventing a condition associated with coagulation, thrombus formation, fibrosis and restenosis at treated vascular sites.
Throughout this Specification, various publications are referenced. The disclosures of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state ofthe art to which the invention pertains.
The preceding examples are intended to illustrate, but not limit the invention.
While they are typical of those that might be used, other procedures known to those skilled in the art may be alternatively employed. As used herein, "a" means one or more than one, depending upon the context.

Claims

WHAT IS CLAIMED IS:
1. An endovascular support device adapted for local delivery of a therapeutic agent and for minimizing the rate of restenosis, comprising:
a. a cylindrical support body having an inside surface and an opposite outside surface; b. at least one layer of pericardial tissue covering at least a portion of at least a selected one of said inside surface or said outside surface of said cylindrical support body; and, c. a therapeutic agent disposed on a portion of said pericardial tissue, thereby adapting said endovascular support device for local delivery ofthe therapeutic agent and for minimizing the rate of restenosis.
2. The endovascular support device of claim 1, wherein said support body is comprised of material selected from the group consisting of a metal and a plastic polymer.
3. The endovascular support device of claim 1, further comprising at least one layer of a polymer on at least a portion of said cylindrical support body.
4. The endovascular support device of claim 3, wherein a second therapeutic agent is disposed on at least a portion of said polymer.
5. The endovascular support device of claim 1, wherein said pericardial tissue is selected from the group consisting of porcine, bovine and human pericardial tissue.
6. The endovascular support device of claim 1, wherein the pericardial tissue has a plurality of micropores therethrough for delivery of said therapeutic agent.
7. The endovascular support device of claim 1, wherein a surface ofthe pericardial tissue has a plurality of micropores thereon for delivery of said therapeutic agent.
8. The endovascular support device of claim 1, wherein said therapeutic agent is disposed upon said pericardial tissue covering at least a portion of said inside surface of said cylindrical support body.
9. The endovascular support device of claim 1, wherein said therapeutic agent is an anticoagulant selected from the group consisting of D-Phe-Pro-Arg chloromethyl ketone, an RGD peptide-containing compound, heparin, an antithrombin compound, a platelet receptor antagonist, an anti-thrombin antibody, an anti-platelet receptor antibody, aspirin, a prostaglandin inhibitor, a platelet inhibitor and a tick anti-platelet peptide, and combinations thereof.
10. The endovascular support device of claim 1, wherein said therapeutic agent is a promoter of vascular cell growth selected from the group consisting of a growth factor stimulator, a growth factor receptor agonist, a transcriptional activator, and a translational promoter, and combinations thereof.
11. The endovascular support device of claim 1, wherein said therapeutic agent is an inhibitor of vascular cell growth selected from the group consisting of a growth factor inhibitor, a growth factor receptor antagonist, a transcriptional repressor, a translational repressor, an antisense DNA, an antisense RNA, a replication inhibitor, an inhibitory
antibody, an antibody directed against growth factors, a bifunctional molecule consisting of a growth factor and a cytotoxin, and a bifunctional molecule consisting of an antibody and a cytotoxin, and combinations thereof.
12. The endovascular support device of claim 1, wherein said therapeutic agent is selected from the group consisting of a cholesterol-lowering agent, a vasodilating agent, and agents which interfere with endogenous vasoactive mechanisms, and combinations thereof.
13. The endovascular support device of claim 1, wherein said therapeutic agent is a smooth muscle inhibitor selected from the group consisting of an agent that modulates intracellular calcium binding proteins, a receptor blocker for contractile agonists, an inhibitor ofthe sodium/hydrogen antiporter, a protease inhibitor, a nitrovasodilator, a phosphodiesterase inhibitor, a phenothiazine, a growth factor receptor agonist, an anti¬ mitotic agent, an immunosuppressive agent, and a protein kinase inhibitor, and
combinations thereof.
14. An endovascular support device adapted for local delivery of a therapeutic agent and for minimizing the rate of restenosis, comprising:
a. a cylindrical support body having an inside surface and an opposite outside surface; b. at least one layer of pericardial tissue covering at least a first portion of at least a selected one of said inside surface or said outside surface of said cylindrical support body;
c. a polymer covering at least a second portion of at least a selected one of said inside surface or said outside surface of said cylindrical support body; and d. a therapeutic agent disposed on said polymer, thereby adapting said endovascular support device for local delivery ofthe therapeutic agent and for minimizing the rate of restenosis.
15. The endovascular support device of claim 14, wherein at least a portion of said pericardial tissue is disposed on at least a portion of said polymer.
16. The endovascular support device of claim 14, wherein at least a portion of said pericardial tissue is disposed between at least a portion of said cylindrical support body and at least a portion of said polymer.
17. The endovascular support device of claim 14, wherein a second therapeutic agent is disposed on at least a portion of said pericardial tissue.
18. The endovascular support device of claim 14, wherein said pericardial tissue is selected from the group consisting of porcine, bovine and human pericardial tissue.
19. The endovascular support device of claim 14, wherein the pericardial tissue has a plurality of micropores therethrough for delivery of said therapeutic agent.
20. The endovascular support device of claim 14, wherein a surface ofthe pericardial tissue has a plurality of micropores thereon for delivery of said therapeutic agent.
21. The endovascular support device of claim 14, wherein said therapeutic agent is an anticoagulant selected from the group consisting of D-Phe-Pro-Arg chloromethyl ketone, an RGD peptide-containing compound, heparin, an antithrombin compound, a platelet receptor antagonist, an anti-thrombin antibody, an anti-platelet receptor antibody, aspirin, a prostaglandin inhibitor, a platelet inhibitor and a tick anti-platelet peptide, and combinations thereof.
22. The endovascular support device of claim 14, wherein said therapeutic agent is a promoter of vascular cell growth selected from the group consisting of a growth factor stimulator, a growth factor receptor agonist, a transcriptional activator, and a translational promoter, and combinations thereof.
23. The endovascular support device of claim 14, wherein said therapeutic agent is an inhibitor of vascular cell growth selected from the group consisting of a growth factor inhibitor, a growth factor receptor antagonist, a transcriptional repressor, a translational repressor, an antisense DNA, an antisense RNA, a replication inhibitor, an inhibitory antibody, an antibody directed against growth factors, a bifunctional molecule consisting of a growth factor and a cytotoxin, and a bifunctional molecule consisting of an antibody and a cytotoxin, and combinations thereof.
24. The endovascular support device of claim 14, wherein said therapeutic agent is
selected from the group consisting of a cholesterol-lowering agent, a vasodilating agent, and agents which interfere with endogenous vasoactive mechanisms, and combinations thereof.
25. The endovascular support device of claim 14, wherein said therapeutic agent is a smooth muscle inhibitor selected from the group consisting of an agent that modulates intracellular calcium binding proteins, a receptor blocker for contractile agonists, an inhibitor ofthe sodium/hydrogen antiporter, a protease inhibitor, a nitrovasodilator, a phosphodiesterase inhibitor, a phenothiazine, a growth factor receptor agonist, an anti¬ mitotic agent, an immunosuppressive agent, and a protein kinase inhibitor, and combinations thereof.
26. An endovascular support device adapted for local delivery of a therapeutic agent and for minimizing the rate of restenosis, comprising: a. a cylindrical support body having an inside surface and an opposite outside surface; b. a first pericardial tissue covering at least a first portion of at least a selected one of said inside surface or said outside surface of said cylindrical support body; and c. a second pericardial tissue covering at least a second portion of at least a
selected one of said inside surface or said outside surface of said cylindrical support body; and d. at least one therapeutic agent disposed in a reservoir between said first pericardial tissue and said second pericardial tissue, thereby adapting said endovascular support device for local delivery ofthe therapeutic agent and for minimizing the rate of restenosis.
27. The endovascular support device of claim 26, further comprising a polymer on at least a portion of said cylindrical support body.
28. The endovascular support device of claim 26, wherein a second therapeutic agent is disposed on at least a portion of said polymer.
29. The endovascular support device of claim 26, wherein said pericardial tissue is selected from the group consisting of porcine, bovine and human pericardial tissue.
30. The endovascular support device of claim 26, wherein the pericardial tissue has a plurality of micropores therethrough for delivery of said therapeutic agent.
31. The endovascular support device of claim 26, wherein a surface ofthe pericardial tissue has a plurality of micropores thereon for delivery of said therapeutic agent.
32. A method of supporting an endovascular vessel and locally delivering a therapeutic agent and πύnimizing the rate of restenosis, comprising inserting in the vessel an endovascular support device comprising: a. a cylindrical support body having an inside surface and an opposite outside surface; b. at least one layer of pericardial tissue covering at least a portion of at least a selected one of said inside surface or said outside surface of said cylindrical support body; and, c. a therapeutic agent disposed on at least a portion of said pericardial tissue, thereby supporting the endovascular vessel and locally delivering the therapeutic agent and __nim__ng the rate of restenosis.
33. A method of replacing a vascular vessel and locally delivering a therapeutic agent and minimizing the rate of restenosis, comprising replacing the vessel with an endovascular support device comprising: a. a cylindrical support body having an inside surface and an opposite outside surface; b. at least one layer of pericardial tissue covering at least a portion of at least a selected one of said inside surface or said outside surface of said cylindrical support body; and, c. a therapeutic agent disposed on at least a portion of said pericardial tissue, thereby replacing the endovascular vessel and locally delivering the therapeutic agent and minimizing the rate of restenosis.
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EP0853465A4 (en) 1999-10-27
AU6905696A (en) 1997-03-27
US6355055B1 (en) 2002-03-12
EP0853465A1 (en) 1998-07-22

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